MEDICARE: DARRELL D PRINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	DP00257	OR

General Provider Information

NPI Number	:	1932397353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARRELL D PRINS

Provider Business Mailing Address
First Line	:	3011 NE WEST DEVILS LAKE RD
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-5131
Country	:	US
Telephone Number	:	541-994-2222
Fax Number	:	541-996-5601

Provider Business Practice Location Address
First Line	:	3011 NE WEST DEVILS LAKE RD
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-5131
Country	:	US
Telephone Number	:	541-994-2222
Fax Number	:	541-996-5601

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DARRELL D PRINS
Credential	:	DPM
Telephone Number	:	541-994-2222

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	05/16/2012

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Directions to “DARRELL D PRINS ” Practice Location

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